High-risk subtypes of chronic lymphocytic leukemia are detectable as early as 16 years prior to diagnosis

Chronic lymphocytic leukemia (CLL) is preceded by monoclonal B-cell lymphocytosis (MBL), a CLL precursor state with a prevalence of up to 12% in aged individuals; however, the duration of MBL and the mechanisms of its evolution to CLL remain largely unknown. In this study, we sequenced the B-cell receptor (BcR) immunoglobulin heavy chain (IGH) gene repertoire of 124 patients with CLL and 118 matched controls in blood samples taken up to 22 years prior to diagnosis. Significant skewing in the BcR IGH gene repertoire was detected in the majority of patients, even before the occurrence of lymphocytosis and irrespective of the clonotypic IGH variable gene somatic hypermutation status. Furthermore, we identified dominant clonotypes belonging to major stereotyped subsets associated with poor prognosis up to 16 years before diagnosis in 14 patients with CLL. In 22 patients with longitudinal samples, the skewing of the BcR IGH gene repertoire increased significantly over time to diagnosis or remained stable at high levels. For 14 of 16 patients with available samples at diagnosis, the CLL clonotype was already present in the prediagnostic samples. Overall, our data indicate that the preclinical phase of CLL could be longer than previously thought, even in adverse-prognostic cases.

Blue-collar work is a risk factor for developing IgG4-related disease of the biliary tract and pancreas

BACKGROUND & AIMS

Immunoglobulin G4-related disease (IgG4-RD) of the biliary tract and pancreas is a fibroinflammatory disease of unknown origin with striking male predominance. We aimed to investigate whether blue-collar work and occupational contaminant exposure are risk factors for IgG4-RD of the biliary tract and pancreas.

METHOD

We performed an age-/sex-matched case-control study in the largest academic medical centers of the Netherlands. Occupational history was surveyed by questionnaires. The International Standard Classification of Occupations (ISCO88) was used to classify jobs. Job exposure matrices ALOHA and DOM were utilized to assess the years individuals were exposed to compounds. The disease control cohort consisted of patients from 6 equally sized groups. Conditional logistic regression was used to assess effects of blue-collar work and exposure to occupational contaminants on developing IgG4-RD of the biliary tract and pancreas.

RESULTS

Overall, 101 patients with IgG4-RD of the biliary tract and pancreas were matched 1:3 to 303 controls. Patients with IgG4-RD had a lower level of education (p = 0.001). Individuals who at least once performed blue-collar work (>1 year), had higher odds of developing IgG4-RD than individuals that only performed white-collar work (odds ratio [OR] 3.66; CI 2.18-6.13; p <0.0001). Being ever exposed (>1 year) to industrial ALOHA (e.g. mineral dust; vapors-dust-gases-fumes) and DOM compounds (e.g. asbestos) resulted in higher odds of IgG4-RD (OR 2.14; 95% CI 1.26-3.16; p <0.001 and OR 2.95; 95% CI 1.78-4.90; p <0.001, respectively).

CONCLUSION

Blue-collar work is a risk factor for developing IgG4-RD of the biliary tract and pancreas putatively driven by exposure to selected industrial compounds; this may explain the striking male predominance among patients.

LAY SUMMARY

Immunoglobulin G4-related disease (IgG4-RD) causes tumor-like lesions and typically affects middle-aged to elderly men. The background and cause of this disease remain relatively unknown. In this study, we identified blue-collar work as a risk factor for developing IgG4-RD of the biliary tract and pancreas, which may explain the striking male predominance among patients. Furthermore, these results suggest that toxic exposure to occupational contaminants may drive autoimmunity in IgG4-RD of the biliary tract and pancreas.

Blood pressure and risk of cancer in the European Prospective Investigation into Cancer and Nutrition

Several studies have reported associations of hypertension with cancer, but not all results were conclusive. We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with the development of incident cancer at all anatomical sites in the European Prospective Investigation into Cancer and Nutrition (EPIC). Hazard ratios (HRs) (95% confidence intervals) were estimated using multivariable Cox proportional hazards models, stratified by EPIC-participating center and age at recruitment, and adjusted for sex, education, smoking, body mass index, physical activity, diabetes and dietary (in women also reproductive) factors. The study included 307,318 men and women, with an average follow-up of 13.7 (standard deviation 4.4) years and 39,298 incident cancers. We confirmed the expected positive association with renal cell carcinoma: HR = 1.12 (1.08-1.17) per 10 mm Hg higher SBP and HR = 1.23 (1.14-1.32) for DBP. We additionally found positive associations for esophageal squamous cell carcinoma (SCC): HR = 1.16 (1.07-1.26) (SBP), HR = 1.31 (1.13-1.51) (DBP), weaker for head and neck cancers: HR = 1.08 (1.04-1.12) (SBP), HR = 1.09 (1.01-1.17) (DBP) and, similarly, for skin SCC, colon cancer, postmenopausal breast cancer and uterine adenocarcinoma (AC), but not for esophageal AC, lung SCC, lung AC or uterine endometroid cancer. We observed weak inverse associations of SBP with cervical SCC: HR = 0.91 (0.82-1.00) and lymphomas: HR = 0.97 (0.93-1.00). There were no consistent associations with cancers in other locations. Our results are largely compatible with published studies and support weak associations of blood pressure with cancers in specific locations and morphologies.

[Associations of short-term evaluation assessments and patient characteristics with the use of coercive measures]

BACKGROUND

Dutch mental health care institutes are currently making a tremendous effort to reduce the number of coercive measures they impose, such as seclusion. Despite this effort, a group of patients are still being subjected to enforced medication or seclusion.

AIM

To obtain more knowledge about which patient characteristics are associated with coercive measures and thereby to identify signs that could be acted upon at an earlier stage to prevent deterioration of the patient's condition and reduce the need for coercive measures.

METHOD

We performed a prospective, naturalistic three-month study involving patients in two acute psychiatric admission wards. To collect the data we required, we used two short-term risk-assessment instruments: the Brøset Violence Checklist (BVC) and the Kennedy Axis V (KA-V). By means of statistical analyses we investigated which patient characteristics were associated with the use of coercive measures.

RESULTS

Of the 179 patients, 52 patients (29%) were subjected to a coercive measure during the admission procedure. The following patient characteristics were found to be associated with coercive measures: a bipolar disorder, involuntarily admission, display of physical violence just before admission, scores on the BVC and the KA-V items assessing 'social skills' and 'violence'. The two BVC items 'attacks on objects' and 'display of physical violence just before admission' were the ones most strongly associated with seclusion.

CONCLUSION

Although the sensitivity of the regression model was modest, the associated patient characteristics, combined with the two short-term risk assessment scores, may be helpful for identifying at an early stage those patients who run a high risk of being subjected to coercive measures.

Abstract 5072: Meta-analysis of genome-wide association studies identifies novel susceptibility loci for follicular lymphoma

Background. Follicular lymphoma (FL) is an indolent B-cell malignancy with a variable clinical course that may transform to more aggressive forms of lymphoma. Previous modestly powered GWAS have reported multiple FL susceptibility loci in the HLA class I and II regions at 6p21.32-33, but novel non-HLA susceptibility loci and the genetic architecture of FL associations in the HLA region remain to be elucidated.

Methods. We conducted the largest GWAS of FL to date consisting of 2,142 cases and 6,221 controls of European ancestry from 22 studies scanned on the Illumina OmniExpress. After imputation of common SNPs using IMPUTE2 and 1,000 Genomes Project v3 data, we conducted a meta-analysis of these data with two previous FL GWAS (n=586 cases, 1,537 controls) and replicated top hits in an additional 629 cases and 4,283 controls. Expression quantitative trait loci (eQTL) analyses were performed to evaluate the effects of associated variants on gene expression. Classical HLA allele imputations and stepwise regression analyses are underway to further characterize the HLA associations.

Results. In the joint meta-analysis, the strongest association with FL risk was observed in the HLA region, where a large number of SNPs showed genome-wide significance (P&lt;5x10-8 to P= 1.84x10-84), particularly in HLA class II at 6p21.32 where several HLA eQTLs were identified (P &lt; 0.05). Outside HLA, we identified four novel loci associated with FL at 11q23.3 (CXCR5, rs4938573; P=3.14x10-15), 11q24.3 (ETS1, rs4937362; P=3.33x10-9), 3q13.33 (CD86, rs2681416; P=9.79x10-11) and 3q28 (LPP, rs6444305, P=2.55x10-8). These novel susceptibility loci were located in four biologically relevant genes involved in immune regulation: CXCR5 and its ligand, CXCL13, are involved in guiding B-cells into the B-cell zones of secondary lymphoid organs as well as T-cell migration. ETS1 is expressed in lymphoid cells and regulates immune cell function including differentiation, survival, and proliferation. CD86 and CD80 are classic members of the B7 costimulatory pathway that is important in maintaining immune function, suppression of autoimmunity and antitumor surveillance. LPP encodes a LIM domain-containing protein of the zyxin family and participates in cell adhesion, cell migration, proliferation and transcription dynamics.

Conclusions. This large GWAS provides further support for the important role of common genetic variation in non-HLA genes and further evidence of the key role that HLA immune-regulatory genes play in the pathogenesis of FL.

Citation Format: Christine F. Skibola, Sonja I. Berndt, James R. Cerhan, Zhaoming Wang, Joseph Vijai, Lucia Conde, Paul de Bakker, Sophia S. Wang, Claire M. Vajdic, Brenda M. Birmann, Susan L. Slager, James McKay, Paige M. Bracci, Alexandra Nieters, Qing Lan, Angela R. Brooks-Wilson, Martha S. Linet, Demetrius Albanes, John J. Spinelli, Roel C.H. Vermeulen, Mark P. Purdue, Meredith Yaeger, Lauren R. Teras, Silvia de Sanjose, Alain Monnereau, Simon Crouch, Jia Nee Foo, Henrik Hjalgrim, Gianluca Severi, Brian K. Link, Kimberly A. Bertrand, Yawei Zhang, Karin E. Smedby, Stephen J. Chanock, Nathaniel Rothman, NHL GWAS Consortium. Meta-analysis of genome-wide association studies identifies novel susceptibility loci for follicular lymphoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5072. doi:10.1158/1538-7445.AM2014-5072

Limits on the cosmological abundance of supermassive compact objects from a search for multiple imaging in compact radio sources

Using very long baseline interferometry we have searched a sample of 300 compact radio sources for examples of multiple imaging produced by gravitational lensing; no multiple images were found with separations in the angular range 1.5--50 milliarcsec. This null result allows us to place a limit on the cosmological abundance of intergalactic supermassive compact objects in the mass range approximately 10(6)M( middle dot in circle) to approximately 10(8)M( middle dot in circle); such objects cannot make up more than approximately 1% of the closure density ( 95% confidence). A uniformly distributed population of supermassive black holes forming soon after the big bang does not, therefore, contribute significantly to the dark matter content of the Universe.

H i Absorption in the Steep-Spectrum Superluminal Quasar 3C 216

The search for H i absorption in strong compact steep-spectrum sources is a natural way to probe the neutral gas contents in young radio sources. In turn, this may provide information about the evolution of powerful radio sources. The recently improved capabilities of the Westerbork Synthesis Radio Telescope have made it possible to detect a 0.31% (19 mJy) deep neutral atomic hydrogen absorption line associated with the steep-spectrum superluminal quasar 3C 216. The redshift (z=0.67) of the source shifts the frequency of the 21 cm line down to the ultra-high-frequency (UHF) band (850 MHz). The exact location of the H i-absorbing gas remains to be determined by spectral line VLBI observations at 850 MHz. We cannot exclude that the gas might be extended on galactic scales, but we think it is more likely to be located in the central kiloparsec. Constraints from the lack of X-ray absorption probably rule out obscuration of the core region, and we argue that the most plausible site for the H i absorption is in the jet-cloud interaction observed in this source.

Superluminal sources

Predictions for the apparent velocity statistics under simple beaming models are presented and compared to the observations. The potential applications for tests of unification models and for cosmology (source counts, measurements of the Hubble constant H0 and the deceleration parameter q0) are discussed. First results from a large homogeneous survey are presented. The data do not show compelling evidence for the existence of intrinsically different populations of galaxies, BL Lacertae objects, or quasars. Apparent velocities betaapp in the range 1-5 h-1, where h = H0/100 km.s-1.Mpc-1 [1 megaparsec (Mpc) = 3.09 x 10(22) m], occur with roughly equal frequency; higher values, up to betaapp = 10 h-1, are rather more scarce than appeared to be the case from earlier work, which evidently concentrated on sources that are not representative of the general population. The betaapp distribution suggests that there might be a skewed distribution of Lorentz factors over the sample, with a peak at gammab approximately 2 h-1 and a tail up to at least gammab approximately 10 h-1. There appears to be a clearly rising upper envelope to the betaapp distribution when plotted as a function of observed 5-GHz luminosity; a combination of source counts and the apparent velocity statistics in a larger sample could provide much insight into the properties of radio jet sources.

Structure and evolution of the compact radio source in NGC 1275

Investigations of the fine-scale structure in the compact nucleus of the radio source 3C 84 in NGC 1275 (New General Catalogue number) are reported. Structural monitoring observations beginning as early as 1976, and continuing to the present, revealed subluminal motions in a jet-like relatively diffuse region extending away from a flat-spectrum core. A counterjet feature was discovered in 1993, and very recent nearly simultaneous studies have detected the same feature at five frequencies ranging from 5 to 43 GHz. The counterjet exhibits a strong low-frequency cutoff, giving this region of the source an inverted spectrum. The observations are consistent with a physical model in which the cutoff arises from free-free absorption in a volume that surrounds the core but obscures only the counterjet feature. If such a model is confirmed, very-long-baseline radio interferometry observations can then be used to probe the accretion region, outside the radio jet, on parsec scales.

Bidirectional motion observed in the compact symmetric object 1946+708

We present the first direct measurements of bidirectional motions in an extragalactic radio jet. The radio source 1946+708 is a compact symmetric object with striking S-symmetry identified with a galaxy at a redshift of 0.101. From observations 2 years apart we have determined the velocities of four compact components in the jet, the fastest of which has an apparent velocity of 1.09 h-1c. By pairing up the components, assuming they were simultaneously ejected in opposite directions, we derive a 1 lower limit on the Hubble constant, H0 > 42 km.s-1.Mpc-1.

An anatomic basis for ultrasound images of the human placenta

Placentas after uneventful pregnancies were perfused under physiologic pressure in the fetal vessels, expanded to their predelivery volume, fixated with 4% formaldehyde, and compared to their ultrasound images in pregnancy. The placentas showed a side arrangement of the fetal cotyledons in contact with the basal plate. The centers of the cotyledons showed an empty space in which the spiral arteries ended. These spaces in the placenta corresponded with transsonic areas of ultrasound. The central spaces were surrounded by a relatively dense shell of villi containing the more or less fibrotic stem villi. This explained the areas of increased echo-density, as seen by ultrasound during the last trimester of pregnancy. The fetal cotyledons, composed of a central cavity and a dense villous shell, were separated by a reticular area. The veins ended at the basal plate in these intercotyledonary areas.